The National Blood Service handles the collection of blood from donors and its provision to hospitals. It collects a total of 2.1 million donations of blood each year. The National Blood Service is made up of regional blood transfusion services (BTS), one of which is the West Midlands Blood Transfusion Service (WMBTS).

The Total Supply Network

Demand Factors and Their Impact on the Total Network

Demand for blood is rising at 2.6% per year.

The Total Supply Network diagram outlines the structure of the supply chain across the National Blood Service.

Demand Factor

Characteristics

Impact on the Network

Demand Variability

Demand for blood and blood products can vary widely across a whole range.

E.g. Demand for platelets can be variable because leukaemia patients may suddenly require platelets when they go into relapse. Platelets have to be of a particular blood group. Range of 200-500 units per day.

The impact on the network is to increase the inventory held especially at leukaemia hospitals to meet this vast range of demand. For blood products with short shelf life, this can lead to waste.

Demand Volatility

Demand for blood and blood products can be volatile caused either by some large scale accident or disaster. Demand may have to be met by delivery from other regional centres.

Maternity hospitals have volatile demand since blood may be required at very short notice.

When donations collected are transferred to other regions, the value added is charged at 34.45 pounds.

This requires a stand-by inventory of an average of 2 units of blood due to regulatory constraints to avoid litigation.

Short-demand deliveries are met by the regional centre’s drivers. Taxis and rail may also be used.

Demand Unpredictability

Although hospitals track their blood and blood product requirements , unforeseen circumstances can cause a big spike in demand.

Demand for blood and blood products can be unpredictable. For example, a large scale accident can trigger a demand for blood and blood products that cannot be met immediately.

Thus there can be a bull-whip effect a shortage of rare blood group products and a surplus of the normal AO Rh +ve blood group products.

Hospital’s innacurate prediction of demand for blood and blood products taxes the network and the hospitals are charged an extra fee for the service.

Demand Changes

Demand in a region can change if an organ transplant programme moves into the region. e.g. The major liver transplant programme at the Queen Elizabeth Hospital in Birmingham.

Increased collection drives in the region affected. In the short-term , blood and blood products may be sourced from other regional centres.

Demand and Supply Mix Mismatch

Races that have very rare blood groups can cause an imbalance between demand and supply mix. e.g. West Indian and African Blacks have very rare blood groups in the U.K.

Increased efforts to collect from ethnic minorities. Also, family members are sourced as the chance of a matching bloog group is 25%.

Registered donors may be called in at short notice to fulfil the demand in emergencies.

Demand from children’s hospitals for fresh blood , not stored for more

than 2 weeks.

A surge in demand for these components can lead to shortage. Regional centres with surplus transfer these blood products to regions of shortage.

The unique characteristics of children’s demand for blood necessitates a supply of fresh blood to children’s hospitals.

Children’s hospitals also act as sources of not-so-fresh blood that can be used by adults who are not that sensitive to the potassium leakage and haemoglobin release in aged blood.

Main Supply Factors and Their Impact on the Network

Supply Factors

Characteristics

Impact on Network

Voluntary Donations

UK policy mandates that donors are not paid for blood or plasma they donate.

The regional blood transfusion service has fully equipped teams that travel out to different sites each day to make it easier for donors.

Donors can also make donations at the fixed location centres without an appointment.

Low Turnout

The West Midlands region has 600,000 donors who are requested to turn up for donations 2 or 3 times a year. The turn out averages at the most 50%. The cause for this low turnout can be attributed to some extent to the hardening of attitude in management to people having time off to give blood.

More effort on blood collections in church halls, youth clubs. The mobile units are put into service to this purpose.

Rare blood group donors are requested to be on a national blood panel. They can be called in at short notice and more frequently to give blood.

Plasma Products

A plasma donor can give 600 ml of plasma per session , but the process takes 1 hour.

Plasma only donors give monthly or even every fortnight. Plasma only donors are preferred as source of plasma since a normal donation separation for plasma must be done within a day, an additional load on the laboratory.

Platelets

Platelets must be made within 6 hours of collection.

Platelets have a short shelf-life.

Collection must be done close to the regional centre to reduce lead-time in platelet production.

High degree of obsolescence/waste. Low inventory held. Therefore their demand is considered first.

Factor VIII

Required by hemophiliacs.

Stored at 4 degrees celsius. Shelf life of 3 years.

The high shelf-life allows a higher level of inventory.

Albumin

4.5 per cent albumin used to treat burn victims who lose body protein and body fluid but don’t bleed.

20 per cent albumin used to raise the protein level of kidney dialysis patients and patients with malabsorption syndromes.

Shelf – life of 3 years.

The high shelf-life allows a higher level of inventory.

Cryoprecipitate

Shelf-life of 6 months stored at -30 degrees celsius or below.

Relatively lower shelf-life. A lower level of inventory.

Red cell concentrate

Freezing done for very rare blood groups. WMBTS and army are the only red cell freezing facilities. Stored at 4 degrees celsius and have a shelf life of 35 days.

Can be stored for much longer periods in liquid nitrogen.

A low level of inventory bacause of a smaller shelf life.

White Cells

Necessary to fight bacterial infection in the body. Very few white cells in each donation. 20 donations may be required for one therapeutic dosage. Stored at 18 degrees celsius. Shelf life of 6 – 8 hours.

Low level of inventory.

Fresh Blood

Only needed in exceptional circumstances such as neonatal heart operations.

Usually collected the morning of the operation. In cases of emergency, a donor may be bled or blood obtained from another regional centre.

Testing Process

The testing is done on 2 separate units. Thus, the collected blood is not made available until the test results are clear. Testing is carried out for Hepatitis B &C, Anti HIV and syphilis. Also depending on demand for CMV free blood, selected blood donations of appropriate groups are tested.

The testing process occurs a day after bleeding, adding a day of lead-time to the blood products. This is unavoidable until faster testing procedures are devised.

Donor Well-being

If a donor is on medication, has a cold , high blood pressure or received an anaesthetic, the donation is deferred.

Deferred Donors have a probability of not turning up for the next session. This reduces the available blood supply.

Network Adaptation To Serve End-Customer Needs

The network has shown the adaptability to meet end-customer needs.

1> The decreasing turn-out of registered donors and the inability to turn up during work hours are now countered by public sessions such as church halls and youth club meetings.

2> The inability of donors to visit the fixed site donor centres are countered by the use of more flexible, low cost mobile units for collection.

3> Emergency blood demand is met either by bleeding a registered donor at short notice or procurement from another regional centre.

4> Emergency deliveries are made to hospitals or to the site of an accident. Short demand deliveries are serviced by the centre’s own drivers, or taxis or rail.

5> Children’s hospitals service other hospitals with blood more than 2 weeks old, that are no longer usable for child patients.

6> Rare blood groups are catered to by keeping rare blood group donors on a national panel so that they can be contacted at short notice.

7> Plasma products require a longer procedure lasting upto 1 hour. Thus, they are registered donors and are called in more frequently like a month or even a fortnight.

Inventory Management Problems

(a) The Hospitals

Hospitals have their own blood banks that are stocked with supplies from the regional blood transfusion centres.

These are used to supply the wards and theatres, based on requests from anaesthetists.

Blood is cross-checked against a patient’s type and reserved. This can occcur upto 3 cycles after which it may be too old to be used. A simpler group and screen test is sufficient in some cases at shorter notice, here less blood is allocated. The hospitals have a problem forecasting blood demand for various operations, which can lead to a shortfall in ordering from the service.

The hospital blood banks face the same problems as the WMBTS , though on a smaller scale, of keeping track of blood and blood products and their expiration dates. Cross-matching takes up more inventory since the blood may not be used. This necessitates an additional demand if an unexpected surge in demand happens at the hospitals.

The short shelf-life of products such as platelets necessitate fresh replenishment orders, increasing costs caused by obsolescence. Short-fall caused by inaccurate demand forecasts lead to addditional orders for which an extra fee is incurred. Children’s hospitals have to use blood less than two weeks old; this is then ttransferrred to other hoospitals thus causing logistical and transfer pricing problems.

(b) The WMBTS

The WMBTS is the regional blood source for the West Midlands region.

The short shelf life of products such as platelets and white blood cells necessitates continuous replenishment. These products are disposed as waste when their shelf life expires. The additional costs incuurred with rare blood groups are not offset in the case of these short shelf-life products thus necessitating a national panel for donors at short notice. An unexpected demand can be sourced from other regional centres, incurrring additional transfer costs, based on availability. These short-shelf life products necessitate a safety level inventory to meet unexpected demands. Availability uncertainty is sought to be reduced by donor panels and transfers from other regions. Family members may also be bled, though this will cause a lead time of one day for testing. (Is test waiving allowed?)

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